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Dos Santos KVR, Leles JLR, Roriz VM, Leles CR. Topographical and histological analysis of keratinized mucosal grafts removal techniques an ex-vivo study in porcine mandibles. Sci Rep 2024; 14:13066. [PMID: 38844764 PMCID: PMC11156962 DOI: 10.1038/s41598-024-58559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/01/2024] [Indexed: 06/09/2024] Open
Abstract
The aim of this study was to assess the surface and tissue quality of keratinized mucosa grafts (KMG) obtained using the conventional scalpel and mucotome techniques. This was an experimental in vitro/ex vivo study involving six porcine hemi-mandibles. Specimens were harvested using both the mucotome and conventional scalpel techniques, with randomization determining the choice of technique for tissue removal. The specimens were prepared following predefined laboratory protocols and subsequently subjected to optical microscopy for evaluating epithelial and connective tissue and scanning electron microscopy for topographical and 3D profilometry analysis. Tissues harvested using the mucotome exhibited a linear base and uniform thickness, along with the presence of submucosa and fibrous connective tissue, all of which are ideal for graft success. Differences in the surface characteristics of specimens obtained through the two techniques were observed during a comparative analysis of images obtained through both microscopy types. KMG obtained using the mucotome technique displayed greater uniformity and reduced undesirable cell presence compared to the scalpel technique, thereby enhancing the likelihood of success in soft tissue graft surgical procedures. This study provides valuable insights to oral healthcare professionals and may contribute to future research aimed at achieving more successful surgeries, shorter postoperative recovery times, reduced discomfort, and an overall more positive patient experience.
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Affiliation(s)
- Kleber Vinícius Rodrigues Dos Santos
- School of Dentistry, Sao Paulo University, Av. Do Café-Subsetor Oeste-11, Ribeirão Preto, SP, 14040-904, Brazil.
- School of Dentistry, Federal University of Goiás, Av. Universitária, s/n-Setor Leste Universitário, Goiânia, GO, 74605-020, Brazil.
| | - José Luiz Rodrigues Leles
- School of Dentistry, Paulista University, Rodovia BR 153, Km 503, s/n Fazenda Botafogo, Goiânia, GO, 74215060, Brazil
| | - Virgílio Moreira Roriz
- School of Dentistry, Federal University of Goiás, Av. Universitária, s/n-Setor Leste Universitário, Goiânia, GO, 74605-020, Brazil
| | - Cláudio Rodrigues Leles
- School of Dentistry, Federal University of Goiás, Av. Universitária, s/n-Setor Leste Universitário, Goiânia, GO, 74605-020, Brazil
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Mainas G, Ruiz Magaz V, Valles C, Mora J, Candiago J, Pascual A, Nart J. Keratinized mucosa changes around one-stage implants: A prospective case series. Clin Implant Dent Relat Res 2021; 24:34-42. [PMID: 34939306 DOI: 10.1111/cid.13053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The need of an adequate band of keratinized tissue (KT) to maintain periodontal health around teeth as well as around implants has been a debated topic over many years but still no conclusions have been drawn. OBJECTIVES This prospective case series evaluates the changes undergone by the keratinized mucosa (KM) and the soft tissue volume around non-submerged implants before the prosthetic rehabilitation. MATERIAL AND METHODS A total of 40 patients were included. The primary outcome was to analyze the width of the KM at both buccal and lingual aspects compared to the pre-existing KT in the edentulous ridge only in mandibular (pre)molar area. The mucogingival line was marked with a surgical pen and an intra-oral scanner was used to take the impression of the implant area the day of the surgery (T0, baseline) and before the crown placement (T1, 3 months). Buccal soft tissue volume was measured at 1, 3, and 5 mm apical to the healing abutment position and a comparison between T0 and T1 was performed. Student t-test was used according to the distribution of the data (Shapiro-Wilk). RESULTS The mean KT width at baseline was 4.54 ± 1.31 mm at buccal side and 5.04 ± 1.88 mm at lingual side. After 3 months, the mean KM values were 3.15 ± 1.03 mm and 3.72 ± 1.56 mm at the buccal and lingual aspects, respectively. The differences, 30.6% of KM reduction buccally and 26.1% of reduction lingually, were statistically significant for both sides. CONCLUSIONS Within the limitations of this investigation, it was observed that the KM width from the baseline to the 3 months follow up presented a significant dimensional change in both the buccal and lingual aspects, whereas buccal soft tissue volume showed an increase between baseline and follow up.
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Affiliation(s)
- Giuseppe Mainas
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanessa Ruiz Magaz
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Javier Mora
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jacopo Candiago
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andres Pascual
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Troiano G, Lo Russo L, Canullo L, Ciavarella D, Lo Muzio L, Laino L. Early and late implant failure of submerged versus non-submerged implant healing: A systematic review, meta-analysis and trial sequential analysis. J Clin Periodontol 2019; 45:613-623. [PMID: 29574852 DOI: 10.1111/jcpe.12890] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this systematic review was to analyse current evidence regarding differences in early and late implant failure as well as in marginal bone level (MBL) changes between submerged and non-submerged healed dental implants. METHODS PUBMED, SCOPUS, EMBASE and Web of Science databases were searched for prospective randomized and non-randomized controlled studies addressing direct comparison between submerged and non-submerged implant healing, without performing immediate loading. Early and late implant failure (before or after 6 months from implant placement, respectively) together with MBL were the investigated outcomes. Risk of bias assessment was performed using the Cochrane Collaboration Tool for Randomized clinical trials. Meta-analysis was performed and the power of the meta-analytic findings determined by trial sequential analysis (TSA). RESULTS Eleven studies met the inclusion criteria and were included in the review. Results of this systematic review revealed a small higher rate (2%) of early implant failure when a non-submerged healing approach is performed. Late implant failure appears not to be different in submerged or non-submerged healing, but the power of evidence, as determined by TSA, is not high. If we consider MBL changes at 1 year from implant load, it seems that non-submerged healing may better preserve marginal bone, although with a small effect size (0.13 mm). CONCLUSIONS Implants placed with a non-submerged technique have a higher risk (2%) of early failure. The power of the evidence about the effects on MBL is low, but present results seem to favour non-submerged healing, although with a very small effect size.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania - Luigi Vanvitelli, Naples, Italy
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Soylu E, Gönen ZB, Alkan A. A New Detection Method for Submerged Implants: Oral Tattoo. J Prosthodont 2016; 27:361-363. [PMID: 29667334 DOI: 10.1111/jopr.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the marking potential of tattoo ink in determining the definitive locations of submerged implants at the time of surgical exposure of the implants. MATERIALS AND METHODS In total, 104 implants in 32 patients were included in this study. After placement of the implants, cover screws were inserted. Overlying mucosa was marked with tattoo ink using a 20 g needle through the center of the cover screw. At the time of surgical exposure the tattoo marks were evaluated relative to visibility. RESULTS At the time of the surgical exposures, tattoo ink was clearly visible at 91 implants, slightly visible at 8 implants, and not visible at 5 implants. After detection and classification of tattoo ink, the overlying mucosa was gently removed by tissue punch under local anesthesia. CONCLUSION The results of this study seemed to indicate that marking the location of implants with tattoos at the time of implant placement can be an inexpensive, easy, healthy, and practical way to identify the location of marked submerged dental implants.
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Affiliation(s)
- Emrah Soylu
- Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Dentistry, Tokat, Turkey
| | - Zeynep Burçin Gönen
- Department of Oral and Maxillofacial Surgery, Erciyes University Genome and Stem Cell Center, Kayseri, Turkey
| | - Alper Alkan
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
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El-Gammal MY, Salem AS, Anees MM, Tawfik MA. Clinical and Radiographic Evaluation of Immediate Loaded Dental Implants With Local Application of Melatonin: A Preliminary Randomized Controlled Clinical Trial. J ORAL IMPLANTOL 2016; 42:119-25. [DOI: 10.1563/aaid-joi-d-14-00277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immediate loading of dental implants in situations where low bone density exist, such as the posterior maxillary region, became possible recently after the introduction of biomimetic agents. This 1-year preliminary clinical trial was carried out to clinically and radiographically evaluate immediate-loaded 1-piece implants with local application of melatonin in the osteotomy site as a biomimetic material. 14 patients with missing maxillary premolars were randomized to receive 14 implants of 1-piece type that were subjected to immediate loading after 2 weeks of initial placement. Group I included 7 implants with acid-etched surface while group II included 7 implants with acid-etched surface combined with local application of melatonin gel at the osteotomy site. Patients were recalled for follow up at 1, 3, 6, and 12 months after loading. All implants were considered successful after 12 months of follow-up. Significant difference (P < 0.05) was found between both groups at 1 month of implant loading when considering the implant stability. At 1 and 3 months there were significant differences in the marginal bone level between the 2 groups. These results suggest that the local application of melatonin at the osteotomy site is associated with good stability and minimal bone resorption. However, more studies for longer follow-up periods are required to confirm the effect of melatonin hormone on osseointegration of dental implants.
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Affiliation(s)
- Mona Y. El-Gammal
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ahmed S. Salem
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Mohamed M. Anees
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Mohamed A. Tawfik
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Liñares A, Domken O, Dard M, Blanco J. Peri-implant soft tissues around implants with a modified neck surface. Part 1. Clinical and histometric outcomes: a pilot study in minipigs. J Clin Periodontol 2013; 40:412-20. [DOI: 10.1111/jcpe.12068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 10/02/2012] [Accepted: 12/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Liñares
- Periodontology Unit; School of Medicine and Dentistry, University of Santiago de Compostela; Santiago de Compostela Spain
| | - Olivier Domken
- Department of Periodontology; University of Liege; Liege Belgium
| | - Michel Dard
- Department of Periodontology and Implant Dentistry; College of Dentistry, New York University; NY USA
| | - Juan Blanco
- Periodontology Unit; School of Medicine and Dentistry, University of Santiago de Compostela; Santiago de Compostela Spain
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El-Gammal M, Ghoneem N, Tawfik H, Madina MA, Maria OM. LASER sintered one-piece early-loaded dental implants for mandibular premolars replacement. J ORAL IMPLANTOL 2013; 41:56-62. [PMID: 23413822 DOI: 10.1563/aaid-joi-d-12-00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study was designed to evaluate laser-sintered early-loaded 1-piece implants (OPI) based on clinical and radiographic findings. Thirty OPI were placed in the mandibular premolar area and subjected to early loading after 3 weeks of initial placement; patients were followed up for 6 months. Clinical evaluation included pocket depth, gingival health, implant stability, and esthetics. Periapical radiographs were used to measure the marginal bone loss (MBL). All implants were considered successful resulting in a survival rate of 100%. A remarkable difference (P < 0.01) existed when comparing MBL levels at 1 month with those at 3 and 6 months. Significant differences (P < 0.01) existed when comparing implant stability at 1 month to 3 months and at 3 months to 6 months. Moreover, significant differences (P < 0.01) were observed when comparing peri-implant probing depth at 1 month to that at 3 and 6 months on both the mesial and distal sides. The mean value of pink esthetic score was 11 at time of final restoration. The laser-treated early-loaded OPI design is associated with satisfactory clinical and radiographic follow-up results and it is a good alternative to the 2-piece design.
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Affiliation(s)
- Mona El-Gammal
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Almeida JMD, Novaes VN, Faleiros PL, Macarimi VC, Bosco ÁF, Theodoro LH, Garcia VG. Aumento de gengiva queratinizada em mucosa peri-implantar. REVISTA DE ODONTOLOGIA DA UNESP 2012. [DOI: 10.1590/s1807-25772012000500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Estudos recentes são direcionados a explorar a relação da faixa da mucosa queratinizada com a saúde dos tecidos peri-implantares. Quando esta faixa não é suficiente, uma cirurgia para o aumento de mucosa queratinizada pode ser indicada, pois tem sido relatado que a presença ou a reconstrução de tecido queratinizado ao redor de implantes pode facilitar os procedimentos restauradores, promover a estética e ainda permitir a manutenção de uma higienização oral rotineira sem irritação ou desconforto ao paciente. Dentre os procedimentos cirúrgicos disponíveis, a técnica do enxerto gengival livre é consagrada na literatura periodontal para aumento da faixa de mucosa queratinizada. OBJETIVO: Este estudo relata um caso clínico em que foi realizada cirurgia de enxerto gengival livre com objetivo de aumentar a faixa da mucosa queratinizada na região de implantes previamente instalados na maxila, para suporte de prótese tipo protocolo. RELATO DO CASO: Foi realizada a cirurgia de enxerto gengival livre na região anterior da maxila, obtido do palato, na qual haviam sido instalados implantes osseointegrados para suporte de prótese tipo protocolo e a mucosa peri-implantar apresentava-se sem tecido queratinizado e inflamada. Após dois meses de reparação da cirurgia mucogengival, foi possível observar que o enxerto gengival livre favoreceu a saúde peri-implantar e os procedimentos protéticos de moldagem. CONCLUSÃO: Diante dos resultados clínicos, pode-se concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para aumento da faixa de mucosa queratinizada em mucosa peri-implantar de prótese protocolo.
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Cairo F, Sanz I, Matesanz P, Nieri M, Pagliaro U. Quality of reporting of randomized clinical trials in implant dentistry. A systematic review on critical aspects in design, outcome assessment and clinical relevance. J Clin Periodontol 2012; 39 Suppl 12:81-107. [DOI: 10.1111/j.1600-051x.2011.01839.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Cairo
- Department of Periodontology; University of Florence; Florence; Italy
| | - Ignacio Sanz
- Department of Periodontology; Universidad Complutense ; de; Madrid; Madrid; Spain
| | - Paula Matesanz
- Department of Periodontology; Universidad Complutense ; de; Madrid; Madrid; Spain
| | - Michele Nieri
- Department of Periodontology; University of Florence; Florence; Italy
| | - Umberto Pagliaro
- Department of Periodontology; University of Florence; Florence; Italy
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Siadat H, Panjnoosh M, Alikhasi M, Alihoseini M, Bassir SH, Rokn AR. Does implant staging choice affect crestal bone loss? J Oral Maxillofac Surg 2011; 70:307-13. [PMID: 22169672 DOI: 10.1016/j.joms.2011.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 09/01/2011] [Accepted: 09/02/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the present study was to compare the crestal bone loss around implants placed according to either a 1-stage or 2-stage implant installation procedure using a digital subtraction radiography technique. MATERIALS AND METHODS In the present randomized clinical trial, screw-shaped tapered implants were inserted in the posterior mandible of patients needing fixed partial dentures. In each edentulous area, according to the randomization table, 1 implant was inserted using a 1-stage procedure (group 1) and 1 was placed using a 2-stage approach (group 2). The implants were temporized with the relined denture after 2 weeks. All implants were functionally loaded with fixed partial dentures after 3 months. Crestal bone loss (primary outcome variable) was measured using a digital subtraction radiography technique. Standardized radiovisiographs were taken after implant insertion, after fixed partial denture installation (3 months after surgery), and after 6 and 12 months of functional loading. The data were analyzed using the Wilcoxon signed ranks test (α = 0.05). RESULTS Eleven patients (mean age 46.9 years, 3 women and 8 men) were included in the study. A total of 34 implants were inserted, 17 using a 1-stage protocol and 17 using a 2-stage protocol. Three months after implant placement, the 2-stage implants showed significantly more crestal bone loss (0.65 ± 0.71 mm) than the 1-stage implants (0.41 ± 0.53 mm; P = .02). However, after 6 and 12 months of functional loading, both groups showed comparable changes in bone level (P > .05). CONCLUSIONS No differences were found between 1-stage and 2-stage implant placement in crestal bone loss after 1 year of functional loading.
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Affiliation(s)
- Hakimeh Siadat
- Implant Research Center and Department of Prosthodontics, Tehran University of Medical Sciences School of Dentistry, Tehran, Iran
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Bilhan H, Geckili O, Mumcu E. The use of definitive implant abutments for the fabrication of provisional crowns: a case series. J Periodontal Implant Sci 2011; 41:248-52. [PMID: 22087416 PMCID: PMC3213236 DOI: 10.5051/jpis.2011.41.5.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/21/2011] [Indexed: 11/08/2022] Open
Abstract
Purpose The anterior region is a challenge for most clinicians to achieve optimal esthetics with dental implants. The provisional crown is a key factor in the success of obtaining pink esthetics around restorations with single implants, by soft tissue and inter-proximal papilla shaping. Provisional abutments bring additional costs and make the treatment more expensive. Since one of the aims of the clinician is to reduce costs and find more economic ways to raise patient satisfaction, this paper describes a practical method for chair-side fabrication of non-occlusal loaded provisional crowns used by the authors for several years successfully. Methods Twenty two patients (9 males, 13 females; mean age, 36,72 years) with one missing anterior tooth were treated by using the presented method. Metal definitive abutments instead of provisional abutments were used and provisional crowns were fabricated on the definitive abutments for all of the patients. The marginal fit was finished on a laboratory analogue and temporarily cemented to the abutments. The marginal adaptation of the crowns was evaluated radiographically. Results The patients were all satisfied with the final appearance and no complications occurred until the implants were loaded with permanent restorations. Conclusions The use of the definitive abutments for provisional crowns instead of provisional abutments reduces the costs and the same results can be obtained.
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Affiliation(s)
- Hakan Bilhan
- Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkey
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Doupis J, Rahangdale S, Gnardellis C, Pena SE, Malhotra A, Veves A. Effects of diabetes and obesity on vascular reactivity, inflammatory cytokines, and growth factors. Obesity (Silver Spring) 2011; 19:729-35. [PMID: 20829804 PMCID: PMC3676733 DOI: 10.1038/oby.2010.193] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the influences of obesity and diabetes on endothelium-dependent and -independent vasodilation, inflammatory cytokines, and growth factors. We included 258 subjects, age 21-80 years in four groups matched for age and gender: 40 healthy nonobese (BMI <30 kg·m(-2)) nondiabetic subjects, 76 nonobese diabetic patients, 37 obese (BMI >30) nondiabetic subjects, and 105 obese (BMI >30) diabetic patients. The flow-mediated dilation (FMD, endothelium-dependent) and nitroglycerin-induced dilation (NID, endothelium-independent) in the brachial artery, the vascular reactivity at the forearm skin and serum growth factors and inflammatory cytokines were measured. FMD was reduced in the nonobese diabetic patients, obese nondiabetic controls, and obese diabetic patients (P < 0.0001). NID was different among all four groups, being highest in the obese nondiabetic subjects and lowest in the obese diabetic patients (P < 0.0001). The resting skin forearm blood flow was reduced in the obese nondiabetic subjects (P < 0.01). Vascular endothelial growth factor (VEGF) was higher in the obese nondiabetic subjects (P < 0.05), tumor necrosis factor-α was higher in the obese diabetic patients (P < 0.0001) and C-reactive protein was higher in both the obese nondiabetic and diabetic subjects (P < 0.0001). Soluble intercellular adhesion molecule-1 was elevated in the two diabetic groups and the obese nondiabetic subjects (P < 0.05). We conclude that diabetes and obesity affect equally the endothelial cell function but the smooth muscle cell function is affected only by diabetes. In addition, the above findings may be related to differences that were observed in the growth factors and inflammatory cytokines.
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Affiliation(s)
- John Doupis
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shilpa Rahangdale
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Salvador E. Pena
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Atul Malhotra
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aristidis Veves
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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